From the Guidelines
This patient likely has acute otitis externa (swimmer's ear) due to water exposure without ear plugs in an ear with a tympanostomy tube, and initial management should include careful cleaning of the external ear canal and topical antibiotic drops. The patient's history of tympanostomy tube insertion and recurrent otalgia and hearing loss suggests a potential complication related to water exposure.
- Initial management should include:
- Careful cleaning of the external ear canal by gentle suction or dry mopping
- Topical antibiotic drops, such as Ciprofloxacin 0.3%/dexamethasone 0.1% otic drops, 4 drops twice daily for 7 days, which provide both antimicrobial coverage and anti-inflammatory effects 1
- The patient should be instructed to keep the ear dry during treatment by:
- Avoiding swimming
- Using a shower cap or cotton ball with petroleum jelly when bathing
- For pain management, acetaminophen or NSAIDs can be used.
- Prevention is crucial, and the patient should:
- Always use waterproof ear plugs when swimming
- Consider using alcohol-based ear drops after water exposure This approach addresses the infection while protecting the middle ear, which is vulnerable due to the tympanostomy tube providing a direct pathway for bacteria from the external ear canal to the middle ear. According to the clinical practice guideline on tympanostomy tubes in children, clinicians should not encourage routine, prophylactic water precautions for children with tympanostomy tubes, but may consider them for subgroups who may benefit from water precautions in specific situations, such as those with a history of recurrent otorrhea or otalgia from water entry into the ear canal 1. If symptoms don't improve within 48-72 hours, reassessment is necessary to consider alternative diagnoses or treatment approaches.
From the FDA Drug Label
The FDA drug label does not answer the question.
From the Research
Management of Recurrent Otalgia and Hearing Loss
- The patient's history of tympanostomy tube insertion and recurrent otalgia and hearing loss after swimming without earplugs suggests a possible correlation between water exposure and ear infections 2, 3, 4, 5.
- However, studies have shown that swimming without earplugs does not result in an increased incidence of middle ear infections 3, 4, 5.
- In fact, a prospective study found that the incidence of otorrhea/otalgia after swimming was not statistically significant between patients who swam with and without water protection 4.
- Another study found that the incidence of otorrhea was not different with or without prescription of ear protection during water exposure among children with tympanostomy tubes 5.
Treatment Options
- For patients with otitis media and associated otorrhea, current treatments include the administration of antibiotic or antibiotic/anti-inflammatory combination drops to the affected ear 6.
- A novel combination drug/hydrogel formulation for the treatment of otitis media/otorrhea has been developed, which releases both ciprofloxacin and dexamethasone over a 2-3 week period 6.
- This formulation has the potential to offer significant advantages over current treatments in use in the clinic, including improved patient compliance and reduced administration difficulties 6.
Recommendations
- Based on the available evidence, it is not necessary to avoid swimming or use water precautions for patients with tympanostomy tubes 2, 3, 4, 5.
- Patients with recurrent otalgia and hearing loss should be evaluated and treated for any underlying ear infections or other conditions that may be contributing to their symptoms 6.